Epidemiology of Untreated Psychoses in 3 Diverse Settings in the Global South
Authors: Craig Morgan, Alex Cohen, Georgina Miguel Esponda, Tessa Roberts, Sujit John, Joni Lee Pow, Casswina Donald, Bola Olley, Olatunde Ayinde, Joseph Lam, Paramasivam Poornachandrika, Paola Dazzan, Fiona Gaughran, Palaniyandi Ponnusamy Kannan, Selvaraju Sudhakar, Jonathan Burns, Bonginkosi Chiliza, Ezra Susser, Helen A. Weiss, Robin M. Murray, Thara Rangaswamy, Oye Gureje, Gerard Hutchinson, Adejoke Agboola, Olawoye Fadahunsi, Olufemi Idowu, Clement Obuene, Akin Ojagbemi, Bamise Olayiwola, Seyi Owoeye, Kulandaiyesu Amaldoss, Jothi Ramadoss Aynkaran, Abirami Balashanmugam, Premalatha Chockalingam, Kruthika Devanathan, Subhashini Gopal, Ramesh Kumar, Padmavati Ramachandran, Karthick Samikannu, Darielle Bharath-Khan, Donella Jadoo, Elysse Marcellin, Elena Raymond, Grace Sooknanan, Lauren Subnaik, Diana Williams
Journal: JAMA Psychiatry (2022)

Importance Less than 10% of research on psychotic disorders has been conducted in settings in the Global South, which refers broadly to the regions of Latin America, Asia, Africa, and Oceania. There is a lack of basic epidemiological data on the distribution of and risks for psychoses that can inform the development of services in many parts of the world. Objective To compare demographic and clinical profiles of cohorts of cases and rates of untreated psychoses (proxy for incidence) across and within 3 economically and socially diverse settings in the Global South. Two hypotheses were tested: (1) demographic and clinical profiles of cases with an untreated psychotic disorder vary across setting and (2) rates of untreated psychotic disorders vary across and within setting by clinical and demographic group. Design, Setting, and Participants The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II) comprises incidence, case-control, and cohort studies of untreated psychoses in catchment areas in 3 countries in the Global South: Kancheepuram District, India; Ibadan, Nigeria; and northern Trinidad. Participants were individuals with an untreated psychotic disorder. This incidence study was conducted from May 1, 2018, to July 31, 2020. In each setting, comprehensive systems were implemented to identify and assess all individuals with an untreated psychosis during a 2-year period. Data were analyzed from January 1 to May 1, 2022. Main Outcomes and Measures The presence of an untreated psychotic disorder, assessed using the Schedules for Clinical Assessment in Neuropsychiatry, which incorporate the Present State Examination. Results Identified were a total of 1038 cases, including 64 through leakage studies (Kancheepuram: 268; median [IQR] age, 42 [33-50] years; 154 women [57.5%]; 114 men [42.5%]; Ibadan: 196; median [IQR] age, 34 [26-41] years; 93 women [47.4%]; 103 men [52.6%]; Trinidad: 574; median [IQR] age, 30 [23-40] years; 235 women [40.9%]; 339 men [59.1%]). Marked variations were found across and within settings in the sex, age, and clinical profiles of cases (eg, lower percentage of men, older age at onset, longer duration of psychosis, and lower percentage of affective psychosis in Kancheepuram compared with Ibadan and Trinidad) and in rates of untreated psychosis. Age- and sex-standardized rates of untreated psychoses were approximately 3 times higher in Trinidad (59.1/100 000 person-years; 95% CI, 54.2-64.0) compared with Kancheepuram (20.7/100 000 person-years; 95% CI, 18.2-23.2) and Ibadan (14.4/100 000 person-years; 95% CI, 12.3-16.5). In Trinidad, rates were approximately 2 times higher in the African Trinidadian population (85.4/100 000 person-years; 95% CI, 76.0-94.9) compared with the Indian Trinidadian (43.9/100 000 person-years; 95% CI, 35.7-52.2) and mixed populations (50.7/100 000 person-years; 95% CI, 42.0-59.5). Conclusions and Relevance This analysis adds to research that suggests that core aspects of psychosis vary by historic, economic, and social context, with far-reaching implications for understanding and treatment of psychoses globally.